Low bone mineral density in pre-menopausal women one year after gastric bypass / Baixa densidade mineral óssea em mulheres pré-menopausadas um ano após bypass gástrico

Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.

Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.

Phase angle and metabolic parameters in severely obese patients / Ángulo de fase y parámetros metabólicos en pacientes con obesidad severa

INTRODUCTION: obese patients present an inflammatory and metabolic profile that leads to oxidative stress and cellular damage. Phase angle is an indicator of cellular integrity and has been proposed as a prognostic parameter for changes in the metabolic profile. OBJECTIVE: to investigate the possible association between phase angle and metabolic parameters in obese patients. MATERIAL AND METHOD: this was a cross-sectional study of adult obese patients who attended a specialized clinic between 2014 and 2016. All patients were ≥ 18 years of age, with a body mass index ≥ 35 kg/m2. All data were obtained from medical records and made part of the clinical protocol. Patients were divided into two groups using a cutoff point for phase angle, and the groups were compared using the Kruskal-Wallis or Chi-squared test for quantitative and categorical variables, respectively. Correlations were identified by Spearman's and Pearson's correlation analyses. All between-group differences were considered statistically significant at p ≤ 0.05. RESULTS: a low phase angle was present in 30.5 % of the 141 patients enrolled in the study. We found an association between low phase angle and presence of hyperuricemia (p = 0.018) when adjusted for waist circumference, dysglycemia, arterial hypertension, and hyperuricemia. There was no correlation between phase angle and the components of body composition. CONCLUSIONS: there is an association of phase angle with uric acid levels, but not with other metabolic parameters

INTRODUCCIÓN: los pacientes obesos presentan un perfil inflamatorio y metabólico que provoca estrés oxidativo y daño celular. El ángulo de fase es un indicador de integridad celular que se ha propuesto como parámetro pronóstico de los cambios del perfil metabólico. OBJETIVO: investigar la posible asociación entre el ángulo de fase y los parámetros metabólicos en pacientes obesos. MATERIAL Y MÉTODO: estudio transversal de pacientes obesos adultos que asistieron a una clínica especializada entre 2014 y 2016. Todos los pacientes tenían ≥ 18 años de edad y un índice de masa corporal ≥ 35 kg/m2. Todos los datos se obtuvieron de los registros médicos y formaron parte del protocolo clínico. Los pacientes se dividieron en dos grupos usando un punto de corte para el ángulo de fase, y los grupos se compararon usando la prueba de Kruskal-Wallis o del chi cuadrado para las variables cuantitativas y categóricas, respectivamente. Las correlaciones se identificaron mediante el análisis de correlación de Spearman y el de Pearson. Todas las diferencias entre grupos se consideraron estadísticamente significativas si p ≤ 0.05. RESULTADOS: se observó un ángulo de fase bajo en el 30,5 % de los 141 pacientes incluidos en el estudio. Encontramos una asociación entre el ángulo de fase bajo y la presencia de hiperuricemia (p = 0.018) cuando se ajustó para la circunferencia de la cintura, la disglucemia, la hipertensión arterial y la hiperuricemia. No hubo correlación entre el ángulo de fase y los componentes de la composición corporal. CONCLUSIONES: el ángulo de fase presenta asociación con los niveles plasmáticos de ácido úrico pero no con otros parámetros metabólicos

Phase angle and metabolic parameters in severely obese patients.

INTRODUCTION: Introduction: obese patients present an inflammatory and metabolic profile that leads to oxidative stress and cellular damage. Phase angle is an indicator of cellular integrity and has been proposed as a prognostic parameter for changes in the metabolic profile. Objective: to investigate the possible association between phase angle and metabolic parameters in obese patients. Material and method: this was a cross-sectional study of adult obese patients who attended a specialized clinic between 2014 and 2016. All patients were ≥ 18 years of age, with a body mass index ≥ 35 kg/m2. All data were obtained from medical records and made part of the clinical protocol. Patients were divided into two groups using a cutoff point for phase angle, and the groups were compared using the Kruskal-Wallis or Chi-squared test for quantitative and categorical variables, respectively. Correlations were identified by Spearman's and Pearson's correlation analyses. All between-group differences were considered statistically significant at p ≤ 0.05. Results: a low phase angle was present in 30.5 % of the 141 patients enrolled in the study. We found an association between low phase angle and presence of hyperuricemia (p = 0.018) when adjusted for waist circumference, dysglycemia, arterial hypertension, and hyperuricemia. There was no correlation between phase angle and the components of body composition. Conclusions: there is an association of phase angle with uric acid levels, but not with other metabolic parameters.

INTRODUCCIÓN: Introducción: los pacientes obesos presentan un perfil inflamatorio y metabólico que provoca estrés oxidativo y daño celular. El ángulo de fase es un indicador de integridad celular que se ha propuesto como parámetro pronóstico de los cambios del perfil metabólico. Objetivo: investigar la posible asociación entre el ángulo de fase y los parámetros metabólicos en pacientes obesos. Material y método: este fue un estudio transversal de pacientes obesos adultos que asistieron a una clínica especializada entre 2014 y 2016. Todos los pacientes tenían ≥ 18 años de edad y un índice de masa corporal ≥ 35 kg/m2. Todos los datos se obtuvieron de los registros médicos y formaron parte del protocolo clínico. Los pacientes se dividieron en dos grupos usando un punto de corte para el ángulo de fase, y los grupos se compararon usando la prueba de Kruskal-Wallis o del chi cuadrado para las variables cuantitativas y categóricas, respectivamente. Las correlaciones se identificaron mediante el análisis de correlación de Spearman y el de Pearson. Todas las diferencias entre grupos se consideraron estadísticamente significativas si p ≤ 0.05. Resultados: se observó un ángulo de fase bajo en el 30,5 % de los 141 pacientes incluidos en el estudio. Encontramos una asociación entre el ángulo de fase bajo y la presencia de hiperuricemia (p = 0.018) cuando se ajustó para la circunferencia de la cintura, la disglucemia, la hipertensión arterial y la hiperuricemia. No hubo correlación entre el ángulo de fase y los componentes de la composición corporal. Conclusiones: el ángulo de fase presenta asociación con los niveles plasmáticos de ácido úrico pero no con otros parámetros metabólicos.

Association Between Cardiovascular Risk Factors and 25(OH)D Levels in Obese Patients.

Background: Obesity is associated with lower levels of 25-hydroxyvitamin D [25(OH)D] and higher cardiovascular risk related to metabolic syndrome (MetS). Our purpose was to investigate if there is an association between levels of 25(OH)D and the components of MetS in an obese sample. Methods: This cross-sectional study enrolled obese patients referred for bariatric surgery in a specialized clinic. Secondary data were gathered as follows: glycemic and lipid profiles, 25(OH)D, anthropometric parameters, and clinical and sociodemographic information. The results were presented as means (standard deviations) or medians and interquartile intervals or absolute and relative frequencies. The patients were divided into three groups based on 25(OH)D terciles for analysis and were compared using ANOVA, Kruskal-Wallis or chi-squared tests. The correlations were calculated by Spearman's or Pearson's correlation tests. Results: We studied 299 patients, with the majority being women (74.9%). The patients' average (SD) age and 25(OH)D level were 36 (9) years and 25.8 (7.5) ng/mL, respectively. There was no association between vitamin D and MetS or its components. A progressive decrease in total cholesterol, low-density lipoprotein cholesterol (LDL-c), and nonhigh-density lipoprotein cholesterol (HDL-c) was observed as the serum vitamin D level increased, although only the latter reached statistical significance (P = 0.033). The correlation analysis showed a negative linear association between 25(OH)D and total cholesterol (r = -0.157; P = 0.047), 25(OH)D and LDL-c (r = -0.164; P = 0.038), and 25(OH)D and non-HDL-c (r = -0.176; P = 0.026). Conclusions: There was a negative correlation between 25(OH)D levels and the atherogenic profile but none with the MetS.

Association between sarcopenic obesity and cardiovascular risk: where are we?

INTRODUCTION: The main changes in the body composition refer to the increase of adipose tissue and/or the decrease of muscular mass, and these changes have effect in many clinical outcomes. Sarcopenic obesity (SO) consists of the presence of excessive adipose tissue and deficit of muscular mass simultaneously. People with SO may have synergistic effect due to obesity and sarcopenia, with increases cardiovascular risk more than obesity itself. OBJECTIVE: To describe the findings in the literature about the association between SO and risk factors and/or cardiometabolic disease (CMD) or cardiovascular disease (CVD). METHODS: An electronic search was done on the following databases: MEDLINE, Scopus, SciELO, LILACS and Web of Science, using the matching expressions and Boolean operators: "obesity sarcopenic" OR "sarcopenic obesity", in the titles of the studies, AND "cardiometabolic disease" OR "cardiovascular disease" OR "metabolic syndrome" OR "insulin resistance", in the abstract. RESULTS: Most of studies are cross-sectional and present many different diagnosis criteria for SO. It was possible to verify the association of the SO and the risk factors and/or CMD or CVD. CONCLUSION: SO is associated with risk factors and/or CMD or CVD. The lack of a consensus about this definition jeopardizes the effective clinical practice and the research about the subject.

Association between sarcopenic obesity and cardiovascular risk: where are we? / Asociación entre obesidad sarcopénica y riesgo cardiovascular: ¿dónde estamos?

Introduction: The main changes in the body composition refer to the increase of adipose tissue and/or the decrease of muscular mass, and these changes have effect in many clinical outcomes. Sarcopenic obesity (SO) consists of the presence of excessive adipose tissue and deficit of muscular mass simultaneously. People with SO may have synergistic effect due to obesity and sarcopenia, with increases cardiovascular risk more than obesity itself. Objective: To describe the findings in the literature about the association between SO and risk factors and/or cardiometabolic disease (CMD) or cardiovascular disease (CVD). Methods: An electronic search was done on the following databases: MEDLINE, Scopus, SciELO, LILACS and Web of Science, using the matching expressions and Boolean operators: «obesity sarcopenic» OR «sarcopenic obesity», in the titles of the studies, AND «cardiometabolic disease» OR «cardiovascular disease» OR «metabolic syndrome» OR «insulin resistance», in the abstract. Results: Most of studies are cross-sectional and present many different diagnosis criteria for SO. It was possible to verify the association of the SO and the risk factors and/or CMD or CVD. Conclusion: SO is associated with risk factors and/or CMD or CVD. The lack of a consensus about this definition jeopardizes the effective clinical practice and the research about the subject (AU)

Introducción: los principales cambios en la composición del cuerpo refi eren el incremento de tejido adiposo y/o la disminución de masa muscular, y estos cambios tienen efecto en varios resultados clínicos. La obesidad sarcopénica (OS) consiste en la presencia simultánea del exceso de tejido adiposo y el déficit de masa muscular. Las personas con OS pueden tener un efecto sinérgico debido a la obesidad y la sarcopenia, lo que incrementa el riesgo de enfermedad cardiovascular, más que la obesidad en sí. Objetivo: describir los hallazgos en la literatura científica sobre la asociación de la SO y los factores de riesgo y/o ECM (enfermedad cardiometabólica) o enfermedad cardiovascular (ECV). Métodos: se realizó una búsqueda electrónica en las siguientes bases de datos: MEDLINE, Scopus, SciELO, LILACS y Web of Science, usando las expresiones coincidentes y los operadores booleanos: «obesidad sarcopénica» o «sarcopénica obesidad», en los títulos de los estudios, y «enfermedad cardiometabólica» o «enfermedad cardiovascular» o «síndrome metabólico» o «resistencia a la insulina», en el abstract. Resultados: la mayoría de los estudios son de corte transversales y presentan diferentes criterios de diagnóstico para la OS. Fue posible verificar la asociación de la OS y los factores de riesgo y/o ECM o ECV. Conclusión: la OS está asociada con los factores de riesgo y/o ECM o ECV. La falta de un consenso sobre esta definición pone en peligro la efectividad de la práctica clínica y la investigación sobre el tema (AU)